Exercise vs Obesity, Metabolic Syndrome, Hypertension, and Diabetes

Have we forgotten the root cause of our current epidemic of metabolic syndrome, hypertension, and diabetes mellitus? It is obesity, often contributed to by a sedentary lifestyle. Could we be doing more to address this fundamental problem? 

A recent publication on this issue caught my eye.¹ I recommend that you read the entire article, but what follows are some key points.

• Physical training lowers blood pressure. Benefits can be obtained with moderate-intensity exercise. (The author proved this benefit with ambulatory blood pressure monitoring.)
• Young people with hypertension have increased sympathetic activity, which can become manifest earlier in life through the phenomenon of “white coat hypertension.” Regular endurance exercise can reduce sympathetic tone and cardiovascular responses to stressors. Insulin sensitivity improves as well.
• Hypertension leads to left ventricular hypertrophy, which increases cardiovascular events. Exercise improves left ventricular structure, wall thickness, and mass.
• Another serious complication in obese, vascular-prone hypertensives is peripheral vascular disease. Carotid intima-media thickness (IMT) is a validated marker for atherosclerotic disease. Even young subjects with early mild hypertension can have abnormal IMTs. Exercise training can induce a greater blood pressure lowering in hypertensives compared with those without hypertension. More important, by improving traditional risk factors, exercise mitigates IMT progression.
• A previous caveat for exercise—isolated athletic systolic hypertension—has been proved to be innocent. Central pressure is not increased in affected individuals. 

The author’s conclusion says it far better than I can: “The data from the literature indicate that regular physical activity in young-to-middle-aged subjects not only lowers BP at rest but also attenuates the BP reaction to stressors . . . a number of studies have shown that aerobic exercise can prevent or retard organ involvement in hypertension of the young . . . it is useful to perform at least 3 to 5 sessions per week . . . for 30 to 60 min . . . [of] aerobic sports such as walking, jogging, running, cycling, and swimming.”

We will not convince everyone. But for those individuals who commit to exercise, the benefits will be worth the primary care effort.  


Reference
1. Palatini P. Cardiovascular effects of exercise in young hypertensives. Int J Sports Med. 2012;33:683-690.